Application for Assistance

MISSION ABERNATHY
Date

MonthDayYear
Date
Application for Assistance
Name

First NameMiddle Name or InitialLast Name
Mailing Address
Physical Address

Street Address Line 2

State / Province

Postal / Zip Code
Phone
Format: (000) 000-0000.
Date of Birth

MonthDayYear
MaleFemale
MarriedSingle
Residents Names & Ages
Hispanic or LatinoAmerican Indian or Alaska NativeNative Hawaiian or Other Pacific IslanderAsianWhiteBlack or African American
YesNo
YesNo
Property Information
How long have you lived at this residence?
YesNo
Lending Institution (If Financed)
Submit a Copy of Deed of Trust of Ownership to this application
YesNo
YesNo
Please say YES to the OUTSIDE repairs you are needing on your home. We will NOT do any inside repairs, electrical, or plumbing.
Siding
Windows (if so, how many)
Paint
Handicap ramp
Other, please explain
Total Family Annual Income
YesNo
Please list ALL sources and amount of income, including any salary, wages, pensions, social security, military pay, or self-employment.
Location of any additional real estate properties
YesNo
Liabilities
List major debts, monthly payments, including credit card debt, all loans, medical and mortgage debt:
Deadline: Return to Mission Abernathy by May 30, 2025.
Agreement
I am not presently planning to, nor do I intend within the next two years, to sell my home. I agree to pay back this program all the money for materials if I sell my home within the two-year period. I, undersigned certify subject to disqualification and/or penalty, that this information is true and correct to the best of my knowledge and belief, and that provisions stayed are accepted and agreed to. You are authorized to confirm my ownership, check my/our criminal, credit and employment history.
Applicants Signature

Clear
Date

MonthDayYear
Date
Spouses Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

MISSION ABERNATHY

Application for Assistance

Property Information

Total Family Annual Income

Liabilities

Agreement